Assessing effects of modification of middle meatal silastic splint after endoscopic sinus surgery for nasal polyps: A randomized controlled study

Abstract

Purpose To investigate the efficacy of middle meatal silastic splint in preventing adhesions after bilateral endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP), and to assess nasal symptoms and endoscopic findings in splinted and non-splinted sides. Methods After completion of ESS, silicon silastic splints were randomly inserted in the middle meatus of one nasal side, while no stent in the other side (control). The surgeon was blinded to the side selection, and splint insertion until removal after 1 week. Patients were followed -up after 1 week, 1 and 6 months. Each side of the nasal cavity was assessed for adhesions, crusting, pus, pain, nasal obstruction, and nasal discharge by endoscopic examination and visual analogue scale. Results Forty-nine patients (98 nasal sides) were included. At the 1st week visit, there was no significant difference between the splinted and non-splinted sides for all investigated parameters. After 1- month, adhesions were seen in 10% of the splinted sides, while it was in 26% of the non-splinted sides (P = 0.037). At the 6 -month follow-up visit, the adhesions rate remained 10% in the splinted sides, however the rate increased to 32% in the non-splinted sides ( P = 0.007). All other examined parameters remained statistically insignificant between both sides throughout the follow -up visits. Conclusions Middle meatal silastic splint is significantly reducing middle meatal adhesions with low complication rate in CRSwNP patients undergoing ESS. Our results support its usage when the middle turbinate is unstable or traumatized during surgery.

Management of the middle turbinate during and after sinus surgery

“…Each side of the nose was randomized to a splint side or nonsplint side. The splint side was noted to have a statistically lower rate of postoperative adhesions at 1 month and 6 months postoperatively [32].…”

“…Custom made silastic stents have also seen a resurgence in use. A randomized controlled study was recently performed by Odat et al using a nonabsorbable silastic splint [32]. Each side of the nose was randomized to a splint side or nonsplint side.…”